The Hawthorns

The Hawthorns is a residential care home providing personal care for up to nine people who have a learning disability or autistic spectrum disorder. At the time of our inspection there were nine people living in the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. Nine people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

The service was exceptionally well-led by a team who were committed to providing an exceptionally high standard of person-centred care. This was confirmed by relatives, healthcare and social care professionals and staff. The provider and management team promoted an open and honest ethos and learned from mistakes. Staff were very dedicated and motivated, they were well trained and there were effective systems to ensure staff remained competent in their role. Staff ensured people were at the heart of the service. The staff and management team were creative, committed and determined to support people to live independent lives and challenge the barriers around supporting people with learning disabilities and autism. People's views about the service were valued and there were effective procedures in place to continually monitor and improve the quality of service people received.

People received a service which was exceptionally responsive to their needs and preferences. The registered manager and staff were highly responsive and skilled at helping people achieve positive outcomes, building confidence, independence and helping develop life skills. Staff went above and beyond to ensure people's needs and lifestyle choices were respected. Technology developed by the provider was embedded in service delivery and supported staff to provide people with genuinely person-centred care. The running of the service centred around the experience of people as individuals and recognised the value of their expertise in how their own care should be delivered and they were fully involved in planning and reviewing the care and support they received. People's communication needs were assessed and understood by staff. People were provided with information in a format which met their needs. Relatives felt confident that any concerns would be taken seriously, and action would be taken to address them

The provider had systems in place to safeguard people from abuse. Staff were aware of each person's safety and how to minimise risks for them. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to reduce the risk of reoccurrence. Systems were in place to recruit staff safely. People were supported with good nutrition and could access appropriate healthcare services.

People had personalised rooms. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by staff who were kind, caring and treated them with dignity and respect. They were relaxed and happy in the company of staff and the registered manager. There was a system in place to respond to any concerns.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 4 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Hawthorns is registered to provide accommodation and personal care for up to nine people who have a learning disability or autistic spectrum disorder.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. All of the people living at the service had their freedom lawfully restricted under a DoLS authorisation.

Relatives told us that their loved ones were cared for by kind and caring staff. Staff undertook appropriate risk assessments for all aspects of a person’s care to keep them safe from harm inside and outside of the service. Care plans were developed to support people’s individual needs. Staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People received their prescribed medicine safely from staff that were competent to do so. The registered provider ensured that there were always sufficient numbers of staff on duty to keep people safe.

People were supported to have a nutritious and balanced diet and hot and cold drinks and snacks were available throughout the day. People had their healthcare needs identified and were able to access healthcare professionals such as their GP and dentist. Staff knew how to access specialist professional help when needed.

People were at the centre of the caring process and staff acknowledged them as unique individuals. Relatives told us that staff were kind and caring and we saw examples of good care practice. People were always treated with dignity and respect. People were cared for by staff that were supported to undertake training to improve their knowledge and advance skills to enable them to perform their roles and responsibilities.

People were supported to have an active life and were encouraged to take part in hobbies and interests of their choice. Relatives commented that their loved ones were well looked after and their wellbeing had improved since moving into the service.

People where able, were supported to make decisions about their care and treatment and maintain their independence. People had access to information in an easy read format about how to make a complaint. Relatives told us that they could approach staff with concerns and knew how to make a formal complaint to the provider.

The registered provider had robust systems in place to monitor the quality of the service and make improvements. Staff had access to professional development, supervision and feedback on their performance. People, their relatives and staff found the registered manager approachable.

We considered the findings of our inspection to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with people using the service and the staff supporting them. We spoke with four people, three relatives by telephone and a visiting training assessor. We also looked at four care records.

Is the service safe?

The service had policies and procedures in relation to the Mental Capacity Act (2005) MCA and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise. The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.

The home had policies and procedures in relation to safeguarding vulnerable adults and whistle blowing. We spoke with care staff who understood what was meant by abuse, knew how to identify signs of abuse and how to report their concerns.

We saw that the service had a programme of regular audits and risk assessments to ensure people were cared for in a safe environment.

The service was safe, visibly clean and hygienic. We saw regular checks were made on the cleanliness of the building. Equipment was well maintained and serviced regularly and therefore did not put people at unnecessary risk. We observed regular maintenance was carried out, for example on electrical and fire equipment to ensure their safety.

Is the service effective?

We observed staff interacting with people and found staff always asked people what they wanted to do and then supported them to do it. This meant people were not encouraged to do things without giving their agreement.

We looked at the care files for four people. We saw their care plans and risk assessments were reviewed monthly and any changes were recorded and signed by the staff member and countersigned by the manager. The care files were in an easy read format with pictures to make them accessible to people who used the service.

Relatives told us they were confident care staff had the knowledge and skills to look after people. One relative said, 'They [staff] know what they are doing.' Another relative told us, 'XX has improved no end, so much. I can sleep at night knowing he can sleep in a nice place.'

Is the service caring?

One relative told us, 'XX has never been happier, really impressed with care that XX gets.'

We saw that the lounge and open plan kitchen/dining room were homely and reflected the needs and preferences of people. At lunchtime people and staff sat together at a large dining table. We noted the atmosphere was relaxed.

Is the service responsive?

We saw people were supported to maintain their independence and to learn new skills. We observed one person, who had arranged their own work experience placement in a local garage prepare their own packed lunch.

We saw that the provider had contingency plans in place in event of an emergency situation.

Is the service well led?

Staff told us they received supervision. One member of staff said, 'I have supervision once a month. We discuss any problems and things that could help the guys [people who lived in the home].'

We spoke with a recently appointed member of staff. They told us that they were well supported by the manager and team leaders through their induction and probationary period.

All the staff we spoke with told us the manager and team leaders were very supportive. One staff member said, 'Leadership is good, can approach for help and support and am listened to.' Another staff member told us, 'Can discuss issues and concerns, XX [manager] is fantastic, very easy to talk to.'

After our visit we spoke with three relatives of people living at the home. They all told us they were pleased with the care their loved ones received. One relative said, 'On the whole they're very very good, xxx never minds going back after being out. That says a lot.'

We saw good interaction between staff and people living at the home. People were supported to be as independent as they could and take part in activities of their choice.

Medicines were administered only by staff who had received the appropriate training. The provider had systems in place for the administration of medicines.

Staff felt supported to deliver good care to people living at the home. Training was delivered on a regular basis. One person told us, 'They know what they are doing and know how to look after me.'

The provider had systems in place to assess and monitor the quality of service that people received on a regular basis although improvements were needed to ensure they were more robust.

Since our visit, the registered manager provided us with documents which showed the provider has approved changes to the staffing system in order to provide a member of staff to sleep during the night in the bungalow complex. This ensured, when occasions arose, the extra member of staff would be able to provide assistance to the person living in 'The Berries' together with another colleague. This meant the main building still had one member of staff on duty should any people need immediate assistance.

We looked at the menus and saw they offered a wide range of hot and cold meals. The manager explained maintaining nutrition was an essential part of the menu offering. Discussions took place between staff and people who lived at the home to promote awareness of nutrition and hydration.

We found the building had been maintained effectively and had a handyman. The standard of decor was good. A member of staff showed us the book where maintenance issues were recorded. We confirmed required maintenance had taken place. People's rooms were personalised and people were surrounded by their own possessions.

We observed the interaction between staff and residents by using the Short Observational Framework Tool (SOFI). We saw staff positively interacted with people frequently. We saw people were engaged in activity by staff members at regular intervals. One member of staff said, 'The staff interact with people really well because we know people's communication skills so well.'

We noted it may be necessary for the two members of staff on duty at night to leave the main building unattended whilst they provided support to the person who lived in an adjacent bungalow.